Developing a Capstone Course within a Health Informatics Program

Developing a Capstone Course within

a Health Informatics Program
by Gary Hackbarth, PhD; Teuta Cata, PhD; and Laura Cole, MBA, PMP

Abstract
This article discusses the ongoing development of a health informatics capstone program in a
Midwest university from the hiring of a program coordinator to the development of a capstone course,
through initial student results. University health informatics programs require a strong academic program
to be successful but also require a spirited program coordinator to manage resources and organize an
effective capstone course. This is particularly true of health informatics masters programs that support
health industry career fields, whereby employers can locate and work with a pool of qualified applicants.
The analysis of students logs confirms that students areas of focus and concern are consistent with
course objectives and company work requirements during the work-study portion of the student capstone
project. The article further discusses lessons learned and future improvements to be made in the health
informatics capstone course.
Key words: capstone course, qualitative analysis, healthcare informatics, CATPAC

Introduction
Are masters degree candidates prepared for the professional world as they approach graduation? This
question hinges on student career choices and the expectations of future employers searching the
applicant pool for just the right person. Universities are caught between competing requirements as they
justifiably teach a range of courses that give students a depth and breadth of knowledge across a broad
range of academic areas while developing academic majors that interest students and target career fields
in the business/healthcare domain. Students leave the university feeling that academia is not totally in
tune with the real world, and potential employers feel that students are unprepared for reality since a
university education does not provide all the necessary background and basic core experiences needed to
succeed in the professional world. Capstone courses serve to bridge this gap.
A well-developed healthcare informatics capstone course can be an essential bridge between students
and the real world.1 Further, this course can serve as a bidirectional link whereby students bring back realworld knowledge to educate fellow students, faculty, and the academic administrators responsible for
developing course materials and providing resources to faculty.2 Employers can become intimately
engaged in the learning process by providing feedback to faculty that improves the programs courses.
The key in developing these relationships is hiring a program coordinator with the professional skills
needed to fine-tune the programs goals, coordinate faculty activities with the needs of industry partners,
and direct students in their final course before graduation. This article discusses the ongoing development
of a capstone course in a health informatics program designed to integrate classroom knowledge with
practical industry experiences within an academic structure by placing students in a professional situation
whereby they perform as real employees but also must reflect upon what they are learning.

Perspectives in Health Information Management, Summer 2012

This article describes the creation of a health informatics program, selection of the program
coordinator, the evolution and development of the health informatics capstone course, and student
performance in the course. Conclusions are drawn from the experience, and recommendations for future
improvement to overcome miscues and move constructively forward are discussed.

Creating a Health Informatics Program

Health informatics is a specialized field of study dating from the 1970s that integrates the concepts of
clinical informatics (the principal focus of which is on patient care) and general healthcare information
systems (IS), which focuses on institutional administration. Targeted business needs range from the
storage, retrieval, and interpretation of information in the context of patient care to the implementation
and management of complex information systems used in the administration of healthcare. The key
players in health informatics include hospitals; physician networks and practice groups; third-party payers
and regulatory agencies; and industry suppliers such as pharmaceutical companies, biotechnology
companies, and vendors of hospital equipment and medical supplies. Within the context of health
informatics, the subfield of clinical informatics focuses on computer applications that address medical
data (collection, analysis, and representation of information).3
A successful health informatics program should have a community focus, a desire to aggressively
revise the curriculum, an existing technology community, an existing healthcare community, and the
desire to leverage regional healthcare needs.4 The distinguishing characteristic for such a program is the
focus on the integration and interoperability of technology within the managerial and communication
context of the healthcare business environment. Martz et al. (2007) discussed the development of a health
informatics graduate program; however, over the intervening years, academic and governmental policy
and business needs have led to an expanded interest in the curriculum, making it necessary to create a
capstone course that meets different stakeholder needs than could be achieved in a typical work-study
program, internship, or co-op.5 The overall health informatics program at this university still addresses
clinical informatics and health IS concerns by focusing on the integration and interoperability of
technology within the context of healthcare management. However, the capstone course was envisioned
to integrate multiple disciplines such as information technology (IT), project management, workflow
analysis, business process redesign, and so forth.
A critical success factor for the program was hiring an aggressive coordinator who could inform
employers of the unique contributions of the program. Students with a medical background needed to be
placed within a medical IT environment where they could demonstrate their new IT skills. Traditional IT
students needed to be in a medical environment where they could practice medical terminology
(vocabulary) and apply their IT skills. Employers selected to participate in the program are required to
assign students to jobs that complement what they have learned rather than jobs that simply require
completing projects that have been on the back burner or just being somebodys assistant for a few
months. It is important to emphasize that the hybrid capstone course uniquely targets students with a
broad range of IT, business, and professional medical backgrounds that addresses the business needs of
the medical community.
The terms internship and capstone course can be used interchangeably in terms of student learning
and experience gained; however, the hybrid approach of our course requires a much closer scrutiny in the
selection of the internship location and the assigned student work experience. Students must work in the
healthcare industry, work in a business area where they have not worked before, participate in a
meaningful activity that broadens their new skill set, and complete regular reports for the program
coordinator. Further, we envisioned a joint selection process that places a student based on educational
requirements and organizational needs.
Upon completion of the capstone course, we wanted graduates to be ready for hiring within the
healthcare industry. Such a graduate would have desirable and proven skills. The closer relationship
between students, the program coordinator, and healthcare organizations would allow for more timely
updates of the curriculum and a work environment with documented student success on both the program

Developing a Capstone Course within a Health Informatics Program

and business sides. This interaction would create a synergistic effect whereby successful students would
be hired or promoted and thus encourage other students and healthcare organizations to participate in the
program.

The Capstone Coordinator

Our Vision
Selecting a capstone coordinator was the first step in creating a sound program. Experience from
similar programs suggested that programs without a champion typically stalled or failed to progress.
Considerable thought went into the type of individual and the complementary skills needed to grow the
type of program we foresaw. In general, we envisioned that students would complement their course work
with some kind of work-study program to establish their credibility as they ultimately sought new
positions within the healthcare industry.
Beyond this vision, we had little funding, some interest from a small number of employers, a few
students interested in the concept, and buy-in from college leadership, who agreed that a capstone
course/program was a future direction in which they wanted the college to go.

Qualifications, Functions, and Job Qualifications

A list of capstone coordinator qualifications was contrived based on what we thought was needed to
advance the program. This list was used to screen applicants and guide the interview process. Candidate
qualifications, functions, and job requirements included the following:

Have strong ties to the state and/or community.

Have a healthcare background.
Have the ability to advise graduate students.
Be a member of the colleges Master of Health Informatics (MHI) program advisory board.
Chair student capstone committees.
Maintain the MHI website.
Have strong references indicating a wide network of contacts.
Participate in the writing of healthcare grants.
Be a leader in the recruitment of students.
Develop community relationships and expand the diversity of organizations considered for
student internships.
Expand the program into the public health sector.
Be familiar with federal, regional, state, and local quality improvement programs and
healthcare initiatives in general.

Student Relationships

Assist students in developing resumes and electronic portfolios.

Mentor students in personal habits and job productivity skills.
Mentor students about the healthcare culture and professional conduct.
Guide students to schedule about 12 hours a week for their capstone experience.
Encourage students to seek a professional mentor.

Capstone Courses in IS and Health Programs

A capstone course is offered toward the end of an academic program and integrates student
knowledge accumulated during previous courses.7, 8 These courses integrate a variety of learning styles,
focus on hands-on experiences, and prepare graduates for the transition to a professional career. Students
should work on a variety of projects utilizing different skills but must also complete documentation that
assesses their training. Faculty members oversee the course and optimize student learning experiences.9

Perspectives in Health Information Management, Summer 2012

A survey of capstone courses brought to light many different approaches and designs that need to be
considered in designing a course.10 A crucial aspect of any course design is deciding which topics and
skills should be the focus of the course.11 Further, a well-thought-out capstone course should be
comprehensive in nature, allowing for a large range of student abilities.12 Beachboard and Beard discuss a
capstone course in information systems at the undergraduate level as being beneficial to students and
requiring faculty who are knowledgeable in the area from both the academic and practitioner
perspectives.13 Murray et al. suggest an assessment-based capstone course that includes the mapping of
project deliverables and tying them to specific learning outcomes.14
Brandon and Pruett discussed the development and implementation of an undergraduate capstone
course on IT management from the student perspective.15 The focus of this course was to create
opportunities for undergraduate students to assess business problems; apply IS skills such as systems
analysis and design, database management, and other skills; and employ creativity and critical thinking,
writing, and presentation skills. The course design included activities such as readings on recent trends in
both business and IT development, analysis of business cases, written and verbal reporting, a team
project, and a capstone project. The results of this study showed that technically focused students
underappreciated or misunderstood the management side of organizations.
Understanding the organizational and management side of a company is important. Masters degree
students at the University of South Florida16 participated in a team-based two-semester capstone course in
which students learned to solve problems and integrate learned skills. Similarly, Steiger had students
work on a project that integrated different business functions and emphasized a hands-on approach to
solve business problems, which offered more learning opportunities than a case-based learning
approach.17 Harper et al. encouraged cooperation between instructors and the use of case studies to help
students better understand business functions and problems.18
Schwartz and Schwartz suggested an alternative approach to capstone courses that involved
coordinated lectures by both faculty and IT professionals, whereby faculty served as facilitators of the
seminars.19 The seminars were an opportunity for students to network with professionals and understand
how learned material applied in a professional setting. Students connected with IT professionals and
recognized the need to master skills such as critical thinking, technical skills, and business skills in order
to establish a successful IT career. Structurally, this course addressed five learning objectives that we
considered integrating into our own program:
1.
2.
3.
4.

Participate in discussions with members of the business community in a small-group setting,

Compare real-world scenarios with prior student learning objectives,
Compare written reflections from class discussions with students own work experiences,
Write a term paper in which students critique their own work environment based on what
they learned from the capstone course, and
5. Make recommendations for their own work environment based on the knowledge they
received during seminars.
Astani suggested an active learning approach to help students understand IS issues from the chief
information officer (CIO) perspective.20 In this capstone course approach, students tied together IS issues
with prevailing attitudes suggested by IS professionals. Current IS issues were identified from IS journals
and were rated by interviewing local CIOs. The interviews and ratings of IS issues encouraged students to
consider the impact of these issues on their business region.
A capstone course founded by the National Institutes of Health/National Institute of Aging focused on
health and sociology issues and emphasized hands-on skills while having students work individually or in
teams to finish their projects.21 In this four-credit-hour capstone course, students learned about
racial/ethnic disparities in managing diabetes. The key aspect of this approach was having students
perform hands-on work with real-world problems.
A pharmacotherapeutics capstone course was designed to integrate knowledge from previous courses
with hands-on pharmacy practice.22 This course included three lecture hours, one hour of recitation, and a

Developing a Capstone Course within a Health Informatics Program

one-hour group project per week. Students worked individually and in teams to develop drug formulary
kits, learn medication utilization criteria, and understand medical, legal, and marketing jargon. Topics
were related to critical care, long-term care, and hospice care; patient management issues in ambulatory
care; and pharmaceutical consultation. An important result was that the course needed to include better
assessment of student problem-solving skills in order to help students better apply their pharmaceutical
knowledge.
Based upon the experiences and lessons learned from other courses, we determined that our capstone
course would mandate on-the-job training in a professional setting. Students would be required to
maintain a log of their experiences and make a formal report at the end of their capstone experience. The
difference between this capstone course and a work-study or internship experience would be the close
coordination and mentoring by the program coordinator. Further, great care would be taken to ensure that
students were placed in the right situation to match their learning needs and the needs of the organization
to which they were assigned. The next section presents the description of the capstone course as
developed for our program.

General Description and Learning Objectives of the Capstone Course

The capstone course in the MHI program is designed to offer students the opportunity to gain realworld experience by working on projects in healthcare delivery organizations. Students are required to
work independently on various applied projects to facilitate selection, implementation, and optimal use of
information technology in a healthcare delivery setting. Students use their professional and academic
knowledge to gain new organizational experiences.6 Prospective students come from a variety of
backgrounds, including nursing, lab work, business analysis, IT security, database administration, and so
forth. Students coming from a medical background are given more IT-focused training and those from a
business background receive training in medical terminology to allow for cross-pollination of ideas and
concepts.
As part of the university accreditation process, active learning occurs throughout the curriculum.
Students participate in the active learning component of the capstone course by involving themselves in
hands-on projects that demonstrate application of student knowledge and development of skills.
Therefore, several course objectives address the active learning component to satisfy accreditation
requirements:

Understand how concepts can be applied in a practical setting.

Practice facilitation and leadership skills by working directly in a healthcare provider
organization or a healthcare business.
Obtain direct knowledge of the impact of technology on the daily workflow of a healthcare
provider organization or healthcare business.

Capstone Course Management

Faculty Coordinator
A faculty coordinator was hired to assist and monitor the health informatics program. The faculty
coordinator started the new position in the fall semester of 2009. Students in the MHI program were
informed that they needed to take two capstone semesters in their final year of the MHI program. Students
are not allowed to self-register for the capstone classes, so in fall 2009, students registered with the
advisor for both the Master of Business Informatics and the Master of Health Informatics programs.
The capstone experience was designed to be two semesters long. Students registered for Capstone I
for the first semester and Capstone II for the second semester. To provide students with an in-depth
learning experience, every attempt was made to have students complete both Capstone I and Capstone II
at the same host organization.

Perspectives in Health Information Management, Summer 2012

Course Requirements and Evaluation

Evaluating students in a capstone course requires a common understanding between faculty (the
program coordinator) and the student. The program coordinator, in the faculty role, must clearly state
responsibilities and expectations, while students must clearly understand what they can expect from
faculty. The program coordinator must facilitate the hands-on experience and contact students on a
regular basis to monitor their progress.
Students can expect their grade to be based upon:
1. Active participation throughout the course. Students must actively participate in scheduled
meetings, contribute to discussions, and participate in learning groups whether formed by
other students or the client facility.
2. Completion of monthly activity logs or status reports in the format provided (see Appendix
1). Student logs help students stay focused on the course objectives and gather regular
information for their final report as the semester progresses.
3. Adherence to the requirements outlined in the course syllabus. Students are required to
formally acknowledge that they have read the course syllabus and understand their
responsibilities (see Appendix 2).
4. Completion of a semester activity plan provided and approved by faculty (see Appendix 3).
5. Completion of a final experience paper covering their capstone experience.
The student is responsible for creating a schedule of planned activities for the semester, along with
goals and objectives, in consultation with and for approval by the program coordinator. Each organization
accepting a capstone student must assign the student a mentor who directly supports the students efforts
to achieve the stated objectives. Monthly activity logs and the final paper should reflect this plan.
Students submit three monthly logs over the course of the semester reflecting their progress in relation to
the activity plan for the month covered. As in any work situation, plans may change based on the needs of
the student and the client organization. If the plan changes, it is the students responsibility to submit a
modified plan with an explanation of why the changes occurred within the monthly log.
The final requirement for the capstone course is the experience paper. The experience paper
demonstrates how the student has applied the concepts learned throughout the MHI program in the
healthcare delivery setting. The log of activities will help students develop this paper.

Student Placement
Each students placement in a suitable client organization is impacted by a number of student and
organizational variables. These variables include the following:

Students employment background,

Extent of students work experience,
Students interests,
Host organizations current need,
Host organizations student internship policies, and
Host organizations administrative policies and procedures.

The capstone experience is different for each student and organization, necessitating that each student
be individually placed. The placement system can best be described as matchmaking. The matchmaking
process is not perfect but does engage the student, the coordinator, and the host organization in a dialogue
that results in a mutual understanding of expectations. The process follows the following steps:
1. Each students class record is reviewed to determine that the student is eligible for the
capstone, that the student has taken the required classes, and that the student has reached the
final year of the program.

Developing a Capstone Course within a Health Informatics Program

2. Each student is interviewed to determine his or her thoughts on and interests for the capstone.
A resume is obtained from the student. The students available days and times are noted.
3. The current active list of host organizations is reviewed for possible projects. Contacts at
organizations are called to see if there any new areas of need.
4. When a good match is found, the proposed capstone experience is discussed with the student
and the host organization contact.
5. If both the student and the organization contact agree, the students resume is sent to the host
organization contact for review.
6. If the host organization contact is interested in the student, an interview is arranged.
7. If the student and the host organization agree to the match, the student is placed at that
organization. The students schedule is worked out, and the organizations specific onboarding process is started.
The program coordinator ensures that the intellectual rigor, scope, and integrity of different projects
remain consistent across students by aligning student backgrounds and experience with the willingness of
a healthcare organization to accept a student. For example, a student with no healthcare or technology
background might be placed in a first-tier support role in a healthcare organization. This allows the
student to gain broad practical experience in various departments and face day-to-day issues. A student
with deep business and healthcare experience could be placed doing special projects for a hospital CIO. A
student with hospital department management experience could be placed within a project to plan and
organize the go-live for a hospital-wide integrated information system. Each capstone builds on the
students educational experience and work background to expand the students practical experience
related to health informatics.
Students sometimes complete their capstone projects within their current place of employment. In this
case, the capstone project must be in a department other than the students home department, the project
must be outside of the students normal job duties, and the time spent on the capstone must be outside of
the students regular work hours. For example, an intensive care unit (ICU) nurse in a large hospital might
work on a system implementation project within the hospitals information technology department.
Similarly, someone with a business background might be assigned to a hospitals workflow planning team
to work with doctors and nurses as a new medical healthcare record system is being implemented.

Capstone Syllabus
The capstone syllabus provided to students contains basic guidelines that are consistent with any
university syllabus but with some differences. The syllabus is provided electronically. Students are
required to sign a form stating that they have read and understand the syllabus (see Appendix 2). This is
done to insure that students understand the rules of conduct for the capstone experience. Additionally, the
syllabus covers basic business conduct while at a host facility, including appropriate dress and proper use
of cell phones or pagers. Because of the unique nature of the healthcare environment, the syllabus also
covers two topics specific to healthcare. The first is a reminder of basic disease transmission precautions.
For instance, students are reminded to wash their hands frequently. Students are also asked not to go to
the capstone site if they are ill or a member of their family is ill. These guidelines became especially
important because of the concern over H1N1 (flu) transmission. The second healthcare-specific topic
covers patient privacy and security. The syllabus reminds students that any host organization business
information is not to be disclosed and that patient information is never to be disclosed in any venue or
format. In addition, each student receives basic HIPAA (Health Insurance Portability and Accountability
Act) privacy and security training during the host facilitys on-boarding process.

Data Collection and Findings

The capstone program was first offered in the spring 2008 semester. The number of students taking
the capstone is approximately four students per course, as shown in Table 1. The authors of this study
were able to collect data on the student experiences in the last two semesters of the capstone program (fall
2009 and spring 2010). There are no data related to the previous semesters of the capstone program.

Perspectives in Health Information Management, Summer 2012

In the fall of 2009, nine students were enrolled in the capstone courses, with four in Capstone I and
five in Capstone II. Figure 1 represents the strength of the students previous IT experience and healthcare
experience in the fall 2009 semester. In the figure, Capstone I students are represented as 1A1D, and
Capstone II students are shown as 2A2E. In this semester, four of the students were placed at large area
medical centers, one student was placed at a medium-sized area hospital, and four other students worked
with a small ambulatory provider practice on the definition of requirements and initial vendor screening
for an electronic health record (EHR) system.
In spring 2010, of the eight students enrolled in the capstone courses, two had healthcare experience
but no IT experience, one had IT experience but no healthcare experience, and five had neither strong
healthcare nor IT experience. One student was placed at a large area medical center, two were placed at
midsized area providers, two worked with the Northern Kentucky University College of Health
Professions on technology initiatives, and the remaining three worked with a local long-term care facility,
the local health department, and a small ambulatory provider.
These groups of students are typical of the students that have enrolled in the program to date. Most of
the students have a background in healthcare, a few have backgrounds in technology, and a few have no
healthcare or technology background.
Another interesting piece of information is how many students are working on projects with their
current employers. As shown in Table 2, in fall 2009, three out of nine students (33 percent) worked on
the projects with their current employers, versus one out of eight students (13 percent) taking a capstone
course in spring 2010. More of the early students had a healthcare background, making it easier to place
them in healthcare IT projects. As the program expanded, students went to more entry-level types of work
to gain credibility and experience.

Assessment
The variety of capstone projects makes assessment of student progress against the learning objectives
challenging. The original learning assessment tool was an experience paper prepared at the end of the
capstone course. During the fall 2009 semester, the program coordinator also began collecting monthly
project logs from each student so that the students involvement in the capstone course could be more
easily monitored. The monthly log also helped students prepare the experience paper. The suggested log
format is found in Appendix 1. In the log and the experience paper, students reflect on applied concepts
learned during their MHI courses, what they learned about the host organization culture, how they
practiced leadership skills, and what they learned about the impact of technological change within a
healthcare organization.
In order to assess what students were doing during their internships, we conducted a text analysis
using CATPAC (http://www.galileoco.com) to analyze student log files. Inductive content analysis is
based in grounded theory and has been used to understand e-mail discussion groups, Listserv discussions,
and other archived textual information.2326
CATPAC is a self-organizing artificial neural network computer program used for analyzing text.
CATPAC reads and understands text by learning the interrelationships among words and phrases found in
the text being analyzed. Text is not pre-coded, nor is it necessary for the analyst to predetermine any
categories in advance.27 CATPAC allows categories to develop from the data by allowing the text being
analyzed to develop into meaningful conceptual groupings. The most important output of the CATPAC
program is a matrix containing the mean response computed for every pair of concepts. CATPAC then
assigns a neuron to each major word in the text and runs a scanning window. Neurons representing each
word are paired with other neurons to create word-by-word paired comparisons, resulting in a dendogram
(cluster analysis) that shows the pattern of relationships between key words and further identifies clusters
of key symbols (concepts).28
All student logs were converted to a single text file for analysis based on the sample size. Table 3 is a
descending frequency list of the 25 words most commonly used in the monthly student log files. Table 3
suggests that students were focused on the appropriate objectives. The significant words emerging from

Developing a Capstone Course within a Health Informatics Program

the data, such as the most frequently used word, learned, all seem to be related to the capstone
informatics course. This finding is not entirely surprising, but it is significant that work, hours, week, and
capstone do emerge as key words, possibly indicating that the students were trying to take advantage of
their internship time. Students were well briefed to put in the hours they needed as part of the course
requirement, and the journals suggest that this requirement was being addressed in a substantive way. The
analysis also might indicate that the students focus was spot-on, at least when they were writing the
journals. This further suggests that the journals have value in keeping students on task and that the
frequent repetition of course-related key words reflects the goals and objectives of the course. This
analysis provides some small degree of confidence that the students focused appropriately on the
objectives of the course.
Table 3 also shows the words EPIC, Juniper, healthcare, project, technology, information, and
system. Currently, many healthcare organizations have projects to upgrade or install systems made by
EPIC, a major provider of EHR systems for hospitals. Juniper refers to a company that builds computer
networks and would logically fit with EPIC and project if healthcare organizations were implementing
EHR systems (healthcare and EHR also appear on the list). BCP, or business continuity planning, also
appears as a key word, suggesting that business and healthcare go together.
Figure 2 shows the strength of relationships between key words. Figure 2 is more informative than
frequency counts because it shows a matrix of relationships between key words. In this figure, the column
height has no significance but only reflects the grouping of words in their relative proximity to each other.
The word groupings reflect key ideas emerging from the data.
In the top left corner of Figure 2, the words discussed, related, procedures, and process are grouped
together. The capstone course allows people trained in IT to move into the healthcare field, where they
would have to learn procedures and processes in a new position. At the far right, healthcare, technology,
and workflow are grouped together, suggesting, by virtue of EPIC and Juniper also being key words, that
processes and procedures were being updated to reflect implementation of EHRs and BCP systems. In the
center, we see capstone, project, information, work, hours, and week grouped together, which likely
reflects student capstone reporting requirements. Without overanalyzing the data, this figure suggests that
capstone students were working on meaningful projects that connected information technology and
healthcare.
The text evaluation showed emergence of the same general concepts and ideas across multiple student
journals. This suggests some consistency in our program and in the directions and guidance being given.
Text analysis is a good tool, but we hesitate to overanalyze the data. The number of students (nine) was
small, the journals were kept in different formats, and entries were made at different times. We think we
can do a better job in the future by encouraging students to use the log as a learning tool rather than a
course requirement.

Lessons Learned from Fall 2009 and Spring 2010

Student experiences and feedback during the fall 2009 semester suggested changes that could be
made to the program. The faculty coordinator sought to improve two areas in particular for the spring
2010 capstone: facilitating the placement of students and revising the structure of the capstone classes.
Due to the complexities of student placement, the time between determining the students particular
needs and the start of the students capstone experience can be several weeks. To facilitate students
beginning their capstone experience the first week of class, the placement effort now starts 90 days before
the students capstone semester. Students are contacted by e-mail and asked to call the program
coordinator if they plan to register for a capstone course in the next semester. The student placement
process is started as soon as contact is made. In the future, notifying the departments of capstone
enrollment intentions 90 days in advance will be listed in the course catalog as a requirement. In addition,
the department is planning to create a capstone committee to augment the programs advisory board,
which is made up of local industry leaders whose organizations are the core sources for placement of
capstone students. The capstone committee will be made up of local healthcare organization middle
management and will provide input on capstone development and placement.

10

Perspectives in Health Information Management, Summer 2012

We also found that students completed their course experience paper in a variety of different formats,
making a formal analysis difficult. In the future, we would like to standardize the report format to address
issues important for improving the course, better ways of supporting our internship industry partners, and
ways of streamlining the course from top to bottom. Our program has been growing, but it is a
manpower-intensive activity. If we want to grow, we need to be more efficient and effective in utilizing
our scarce resources.
Starting with the spring 2010 semester, the faculty coordinator revised the structure of the capstone
class. The changes were intended to facilitate the learning assessment of each student. Students are
required to complete three assessment activities. These assessments are as follows:
1. A semester activity plan is submitted within two weeks of the beginning of the capstone.
2. The student submits a monthly log each month (minimum of three) during the semester.
3. At the end of the semester, the student submits an experience paper.
More effort is needed to document the student-mentor relationship. Reducing the administrative
burden on a hosting organization is a concern, but perhaps students could document the student-mentor
relationship within their activity logs.

Student Comments and Future Directions

The evolution of our healthcare informatics program is ongoing.29 As the program grows and matures,
our ability to collect and analyze data will improve as well. We have not yet formally surveyed employers
about their capstone experiences. Our initial thought process was to get organized in a way that would
allow us to manage growth and build a strong reputation with a small number of employers and students
at the outset. Anecdotal evidence suggests that employers are happy with our students and desire more
capstone students, while the number of students entering the program is increasing. Clearly, more data
will be collected in the future to better understand what skills employers need and use and what political
and managerial skills students need; we also need to do a better job of providing feedback to the academic
side, where the courses are taught.
The student experience papers provide some insight as to where we might start. In a comment typical
of many students, the following paraphrases one international student: It is worthy to state here that my
coursework helped me greatly to understand the needs of my assigned organization and how I could help
to provide meaningful solutions to the challenges they face. Courses like Database Management, System
Analysis and Design, Technical Foundation in Health Informatics, and IT Project Management were the
key to my success. Without these courses, I would have been a stranger to the project. However, courses
like Data Mining/Data Warehousing and Data Communication would have helped me greatly. I would
have also done a little better if I had had some programming experience or knowledge. A more
experienced traditional student stated: My coursework and past experience in the industry was used to
leverage knowledge in new areas that I had not previously been exposed to in my twenty-year informatics
career. Clearly, we need more specific understanding of which skills and which courses matter the most.
Political skills complement good technical skills. A student with industry experience stated:
Infrastructure was not one of my strengths but through my research, observation and interviewing skills,
[I] was able to win over the Director by documenting his pain points and bringing a heightened
awareness [of] potential risks that had previously been identified but had fallen on deaf ears. Not all of
the students have this degree of understanding of organizational political processes, so we must consider
how to impart this knowledge through training or mentoring.
Additionally, faculty and administration need to understand and appreciate the importance of the
capstone coordinator in order to ensure the continued funding of this critical position. A student wrote
that the weekly status updates with the Capstone Project Coordinator help tremendously in problem
solving issues/concerns and concepts that needed strengthening and clarification. Thanks [name omitted]
for putting up with me each week!

Developing a Capstone Course within a Health Informatics Program

Expected Benefits
The establishment of a formal program guided by a dedicated program manager sent the right signals
to students, faculty, administrators, other colleges and universities, and the regional business community.
It said we were serious, committed, and in the game for the long term. Over time, we expect to grow the
program, continue to improve the quality of the capstone course, and increase the quality and number of
dedicated students.
Students who know that they will need to complete a two-semester capstone course tend to work
harder at their core courses. Further, there is competition for positions with the best capstone
organizations. We will not send any student just anywhere; the student basically interviews with faculty
and the program administrator to get a good slot. Thus, a good reputation, credibility, work ethic, and
other intangibles, in addition to grade point average, have an impact on a students placement. Even
students who complete a capstone experience within their current organization must sell their
organization on the capstone.
A well-run program can be copied and emulated in other programs and organizations, not just
healthcare. We have attempted to use best practices from other programs and the literature, along with
innovation and creativity, to create a successful capstone program with limited resources. We have shared
our ideas with others around the campus and the region in an effort to market our program as one that,
while not necessarily unique, stands out among the competition.

Conclusions
A successful healthcare capstone course builds success on a number of levels. Students build
confidence in what they have learned. They interview better and increase their likelihood of being hired.
The faculty receives feedback from employers and students that allows incremental improvement of
course materials on a regular basis. Employers get to see the students in action in a low-risk arrangement.
Further, the word gets out to the community and to other students that students are being hired and are
doing well. Successful students bring in more successful students. The program grows, and with growth
come more resources. Successful firms hire more of the programs graduates, contributing to the alumni
network and increasing the likelihood of receiving additional resources in future years. We see the
investment in a capstone course as both a short-term win and a winning investment in the future.

Gary Hackbarth, PhD, is an assistant professor in the College of Informatics at Northern Kentucky
University in Highland Heights, KY.
Teuta Cata, PhD, is an associate professor in the College of Informatics at Northern Kentucky
University in Highland Heights, KY.
Laura Cole, MBA, PMP, is a project manager for Catholic Health Initiatives in Lexington, KY.

12

Perspectives in Health Information Management, Summer 2012

Notes
1.
2.
3.

4.
5.
6.
7.
8.

9.
10.
11.

12.

13.

14.
15.

16.

17.
18.

19.

Norris, A. C., and J. M. Brittain. Education, Training and the Development of

Healthcare Informatics. Health Informatics Journal 6, no. 4 (2000): 18995.
Alpay, L. L., and K. S. Littleton. Contexts for Collaboration in Healthcare Education.
Health Informatics Journal 7, no. 3 (2001): 12126.
Martz, B., X. Zhang, and G. Ozanich. Developing an Integrative Health Informatics
Graduate Curriculum. Communications of the Association for Information Systems 19,
article 30 (2007): 64554.
Ibid.
Ibid.
Huang, Q. R. Competencies for Graduate Curricula in Health, Medical and Biomedical
Informatics: A Framework. Health Informatics Journal 13, no. 2 (2007): 89103.
Jervis, K. J., and C. A. Hartley. Learning to Design and Teach an Accounting
Capstone. Issues in Accounting Education 20, no. 4 (2005): 31139.
University of Nebraska Kearney. College of Business and Technology Departments and
Programs Assessment. 2011. Available at
http://www.unk.edu/academicaffairs/assessment.aspx?id=9163.
Ibid.
Steiger, D. M. Enhancing Knowledge Integration: An Information System Capstone
Project. Journal of Information Systems Education 20, no. 1 (2009): 1723.
McNeil, B. J., and S. K. Odom. Nursing Informatics Education in the United States:
Proposed Undergraduate Curriculum. Health Informatics Journal 6, no. 1 (2000): 32
38.
Murray, M., J. Prez, and M. Guimaraes. A Model for Using a Capstone Experience as
One Method of Assessment of an Information Systems Degree Program. Journal of
Information Systems Education 19, no. 2 (2008): 197208.
Beachboard, J., and D. V. Beard. Innovation in Information Systems Education-II:
Enterprise IS Management: A Capstone Course for Undergraduate IS Majors.
Communications of the Association for Information Systems 15, article 18 (2005).
Murray, M., J. Prez, and M. Guimaraes. A Model for Using a Capstone Experience as
One Method of Assessment of an Information Systems Degree Program.
Brandon, D., and J. Pruett. Experiences in Developing and Implementing a Capstone
Course in Information Technology Management. Journal of Information Technology
Education 1, no. 2 (2002): 91102.
Marshall, G. W., S. E. Bolten, and P. J. Solomon. The Capstone Integrated Business
Application Course: Addressing the Need for Cross-Functional MBA Education.
Marketing Education Review 10, no. 3 (2000): 6375.
Steiger, D. M. Enhancing Knowledge Integration: An Information System Capstone
Project.
Harper, J. S., S. W. Lamb, and J. R. Buffington. Effective Use of Case Studies in the
MIS Capstone Course through Semi-formal Collaborative Teaching. Journal of
Information Systems Education 19, no. 4 (2008): 41118.
Schwartz, R. B., and B. N. Schwartz. Bringing IT Professionals and Graduate Students
Together: A Capstone Course in an IT Program. Journal of Information Systems
Research 8, no. 1 (2006): 10322.

Developing a Capstone Course within a Health Informatics Program

20.
21.

22.

23.
24.
25.
26.

27.

28.
29.

Astani, M. The MIS Capstone Course: An Active Learning Approach. Issues in

Information Systems 7, no. 1 (2006): 11923.
Robbins, E. J., J. M. Kinney, and C. S. Kart. Promoting Active Engagement in Health
Research: Lessons from an Undergraduate Gerontology Capstone Course. Gerontology
and Geriatrics Education 29, no. 2 (2008): 10523.
Cheng, J. W. M., B. Fidler, J. M. Rosenberg, and L. Mihm. Implementation of a
Capstone Pharmacotherapeutics Course in the Entry-Kevel Doctor of Pharmacy
Program. Pharmacy Education 2, no. 3 (2002): 10716.
Glasser, B. G., and A. L. Strauss. The Discovery of Grounded Theory. New York: Aldine,
1967.
Lincoln, Y. S., and E. G. Cuba. Naturalistic Inquiry. Newbury Park: Sage, 1985.
Pennington, T., C. Wilkinson, and J. Vance. Physical Educators Online: What Is on the
Minds of Teachers in the Trenches? Physical Educator 61, no. 1 (2004): 4556.
Hackbarth, G., and J. McQuade. Information Completeness: A Qualitative Analysis of
Indoor Air Quality (IAQ). International Journal of Healthcare Delivery Reform
Initiatives (IJHDRI) 1, no. 2 (2009): 129.
Doerfel, M. L., and G. A. Barnett. A Semantic Network Analysis of the International
Communication Association. Human Communication Research 25, no. 4 (1999): 589
603.
Hackbarth, G., and J. McQuade. Information Completeness: A Qualitative Analysis of
Indoor Air Quality (IAQ).
Martz, B., X. Zhang, and G. Ozanich. Developing an Integrative Health Informatics
Graduate Curriculum.

14

Perspectives in Health Information Management, Summer 2012

Figure 1
Student Levels of Healthcare and IT Background in the Fall 2009 Semester

STRONG IT

1D

2C
2D
2B
2E

1C

STRONG HEALTHCARE

NO HEALTHCARE

2A

1A
1B

NO IT

Note: 1A1D represent Capstone I students, and 2A2E represent Capstone II students.

Developing a Capstone Course within a Health Informatics Program

Figure 2
Strength of Relationships between Key Words
B D R P P C E S S C P I W H W J C E L T P S H T W
C I E R R U H I T A R N O O E U A P E I A Y E E O
P S L O O R R T A P O F R U E N R I A M T S A C R
. C A C C R . E F S J O K R K I E C R E I T L H K
. U T E E E . . F T E R . S . P . . N . E E T N F
. S E D S N . . . O C M . . . E . . E . N M H O L
. S D U S T . . . N T A . . . R . . D . T . C L O
. E . R . . . . . E . T . . . . . . . . . . A O W
. D . E . . . . . . . I . . . . . . . . . . R G .
. . . S . . . . . . . O . . . . . . . . . . E Y .
. . . . . . . . . . . N . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . ^^^ . . . . . .
. ^^^ . . . . . . . . . . . . . . ^^^ . . . . . .
. ^^^ . . . . . . ^^^ . . . . . . ^^^ . . . . . .
. ^^^ . . . . . . ^^^ . . . . . ^^^^^ . . . . . .
. ^^^ . . . . . . ^^^ ^^^ . . . ^^^^^ . . . . . .
. ^^^ . . . . . . ^^^ ^^^ ^^^ . ^^^^^ . . . . . .
. ^^^^^ . . . . . ^^^ ^^^ ^^^ . ^^^^^ . . . . . .
. ^^^^^ . . . . . ^^^^^^^ ^^^ . ^^^^^ . . . . . .
. ^^^^^ . . . . . ^^^^^^^ ^^^ . ^^^^^^^ . . . . .
. ^^^^^ . . . . . ^^^^^^^ ^^^ . ^^^^^^^^^ . . . .
. ^^^^^^^ . . . . ^^^^^^^ ^^^ . ^^^^^^^^^ . . . .
. ^^^^^^^ . . . . ^^^^^^^^^^^ . ^^^^^^^^^ . . . .
^^^^^^^^^ . . . . ^^^^^^^^^^^ . ^^^^^^^^^ . . . .
^^^^^^^^^ . . . . ^^^^^^^^^^^^^ ^^^^^^^^^ . . . .
^^^^^^^^^ . . . . ^^^^^^^^^^^^^ ^^^^^^^^^ . ^^^ .
^^^^^^^^^^^ . . . ^^^^^^^^^^^^^ ^^^^^^^^^ . ^^^ .
^^^^^^^^^^^^^ . . ^^^^^^^^^^^^^ ^^^^^^^^^ . ^^^ .
^^^^^^^^^^^^^ . . ^^^^^^^^^^^^^ ^^^^^^^^^ . ^^^^^
^^^^^^^^^^^^^ ^^^ ^^^^^^^^^^^^^ ^^^^^^^^^ . ^^^^^
^^^^^^^^^^^^^ ^^^ ^^^^^^^^^^^^^ ^^^^^^^^^^^ ^^^^^
^^^^^^^^^^^^^^^^^ ^^^^^^^^^^^^^ ^^^^^^^^^^^ ^^^^^
^^^^^^^^^^^^^^^^^ ^^^^^^^^^^^^^ ^^^^^^^^^^^^^^^^^
^^^^^^^^^^^^^^^^^ ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

16

Perspectives in Health Information Management, Summer 2012

Table 1
Capstone Participation by Semester

Semester
Fall 2008
Spring 2009
Summer 2009
Fall 2009
Spring 2010

Number of
Capstone I
Students
1
4
4
4
4

Number of
Capstone II
Students
0
1
3
5
4

Developing a Capstone Course within a Health Informatics Program

Table 2
Capstone Students Working for Their Current Employers
Capstone I
Capstone II
With
With
Semester
Total Employer Total Employer
Fall 2009
4
1
5
2
Spring 2010
4
0
4
1

18

Perspectives in Health Information Management, Summer 2012

Table 3
Descending Word Frequency List
Word
learned
information
system
EPIC
site
current
healthcare
project
discussed
capstone
hours
work
week
technology
patient
process
related
procedures
time
workflow
care
EHR
Juniper
staff
BCP

Frequency

Percentage

47
40
40
37
34
33
33
33
32
31
30
29
28
26
23
23
23
22
22
22
21
21
21
21
20

6.6
5.6
5.6
5.2
4.8
4.6
4.6
4.6
4.5
4.4
4.2
4.1
3.9
3.7
3.2
3.2
3.2
3.1
3.1
3.1
2.9
2.9
2.9
2.9
2.8

Developing a Capstone Course within a Health Informatics Program

Appendix 1
Student: _________________________
Project: ___________________________
Time Period Covered: _______________
1. What progress did you make on your planned capstone activities for this month? What
progress did you make on your learning goals and objectives this month? What value did
you add to your client organization? Were there other significant accomplishments this
period?
2. Did you encounter any significant barriers? How did you overcome each?
3. What resources did you use (websites, books, articles, magazines, etc.)?
4. Did your course work help you with your accomplishments or to overcome any barriers
encountered? What would have made your coursework more helpful?
5. Did you learn anything about the corporate culture at your site?
6. Did you learn anything about providing healthcare or working in the healthcare
environment?
7. Did you learn anything about the impact of technology on the workflow of providing
healthcare or the business of healthcare?
8. How many hours per week did you work on your capstone project this period?

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Perspectives in Health Information Management, Summer 2012

Appendix 2
Sample Syllabus Acknowledgment

Course Number: xxx

Course Title: MHI Capstone I and MHI Capstone II
Spring 20__
Student Name: ______________________________
Host Facility: _______________________________
Host Supervisors Name: ______________________
I have read and understand the MHI Capstone Project class syllabus posted on Blackboard.
Signature: ______________________________________
Date: __________________________________________

Developing a Capstone Course within a Health Informatics Program

Appendix 3
Student: _____________________________
Project: _____________________________
Semester: ___________________________
1. What are your planned capstone activities by month this semester? This should be a brief,
concise statement.
2. What are your capstone learning goals and objectives this semester? Your planned
capstone activities should support your learning goals and objectives.
3. What value will you be providing to your client organization this semester? Your planned
capstone activities should support the value you will provide to your client organization.